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HealthSpring TotalCare (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSpring TotalCare (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSpring TotalCare (HMO D-SNP) in 2026, please refer to our full plan details page.
HealthSpring TotalCare (HMO D-SNP) is a HMO D-SNP plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in South Florida. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HealthSpring TotalCare (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
HealthSpring TotalCare (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HealthSpring TotalCare (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For HealthSpring TotalCare (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.80. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4500.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The HealthSpring TotalCare (HMO D-SNP) prescription drug plan has an annual drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay when using a preferred pharmacy or preferred mail order, while standard pharmacies charge a $19 copay for a one-month supply. Tier 2 generic medications carry a $20 copay for a one-month supply, though you can secure a three-month supply with no copay through preferred mail order. For brand-name and specialty medications, your costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 23% coinsurance, whereas Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. These coinsurance percentages remain the same whether you use preferred or standard pharmacies and mail-order services.
Additional Benefits
HealthSpring TotalCare (HMO D-SNP) offers comprehensive coverage with no copays and no coinsurance for many everyday health needs, including primary care, preventive services, home health, and cardiac rehabilitation. Members also enjoy no copays or coinsurance for routine hearing and vision exams, eyewear up to a two hundred seventy-five dollar annual limit, and comprehensive dental care up to a three thousand five hundred dollar yearly limit. For more intensive medical services, the plan features a one hundred fifty dollar daily copay for the first five days of inpatient hospital stays, while outpatient services range from no copay to a one hundred fifty dollar copay. Additionally, durable medical equipment and dialysis require a twenty percent coinsurance with no copay, and emergency room visits carry a one hundred thirty dollar copay that is waived if you are admitted.
Inpatient Hospital See details
HealthSpring TotalCare (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $150 copay per day for days 1 through 5 and no copay for days 6 through 90. While unlimited additional days are covered for acute care, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HealthSpring TotalCare (HMO D-SNP) covers outpatient hospital services with a $0 to $150 copay and observation services with a $150 copay, both with no coinsurance. Ambulatory surgical center and blood services have no copay and no coinsurance, and while some outpatient substance abuse services are covered, individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSpring TotalCare (HMO D-SNP) with an $85.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HealthSpring TotalCare (HMO D-SNP), featuring a $200 copay and no coinsurance for ground transport, alongside a 20% coinsurance and no copay for air ambulance services. The plan also partially covers transportation, providing up to 40 one-way trips per year to plan-approved locations with no copay or coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
HealthSpring TotalCare (HMO D-SNP) covers emergency services with a $130 copay and urgently needed services with a $20 copay, both featuring no coinsurance and waived copayments if you are admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with a $130 copay and no coinsurance, up to a maximum plan limit of $50,000.
Primary Care See details
HealthSpring TotalCare (HMO D-SNP) primary care benefits feature no copay and no coinsurance for covered services, including primary care physician visits, specialist services, occupational therapy, physical therapy, telehealth, and opioid treatment. Podiatry is not covered, and while some chiropractic, mental health specialty, and psychiatric services are covered, routine and other chiropractic care, as well as individual and group therapy sessions, are not covered.
Preventive Services See details
Preventive services are covered by HealthSpring TotalCare (HMO D-SNP) with no copay and no coinsurance, including annual physical exams, kidney disease education, and a fitness benefit. This benefit is partially covered, as additional services like health education, weight management, in-home safety assessments, and medical nutrition therapy are not covered.
Hearing Services See details
HealthSpring TotalCare (HMO D-SNP) covers annual routine hearing exams and fitting evaluations with no copay, no coinsurance, and a required referral. Hearing aids are partially covered, offering up to two OTC devices per year with a $399 copay and no coinsurance, and up to two prescription hearing aids with a $399 to $1,800 copay and no coinsurance, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Vision Services are partially covered by HealthSpring TotalCare (HMO D-SNP) with no copay, no coinsurance, and no deductible for covered services. The plan covers one routine eye exam per year and provides a $275 annual maximum benefit for eyewear, including contact lenses and one pair of eyeglasses, though other eye exam services are not covered.
Dental Services See details
HealthSpring TotalCare (HMO D-SNP) covers comprehensive dental services with no copay and no coinsurance, including preventive care, restorative work, and implants. These benefits are subject to a $3,500 maximum annual coverage limit, and prior authorization is required for Medicare-covered dental services.
Home Infusion bundled Services See details
HealthSpring TotalCare (HMO D-SNP) covers Home Infusion bundled Services with no copay, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy, insulin, and other drugs require no coinsurance to 20% coinsurance, with insulin drugs also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered by HealthSpring TotalCare (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
HealthSpring TotalCare (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes with no copay and a 20% coinsurance, subject to prior authorization. This medical equipment benefit is partially covered, as diabetic supplies are not covered by the plan.
Diagnostic and Radiological Services See details
HealthSpring TotalCare (HMO D-SNP) covers diagnostic and radiological services, requiring prior authorization and referrals for all care. Diagnostic procedures and diagnostic radiological services require a copay with no coinsurance, while outpatient X-rays and lab services feature no copay but require coinsurance, and therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
HealthSpring TotalCare (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under HealthSpring TotalCare (HMO D-SNP) with no copay and no coinsurance, although prior authorization and referrals are required. Only some services are covered, as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring TotalCare (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HealthSpring TotalCare (HMO D-SNP) partially covers other services, offering over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit provides up to $110 every three months for health products, and the meal benefit supports members recovering at home from chronic or medical conditions.
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